Provider Enrollment Revalidation

The Centers for Medicare & Medicaid Services (CMS) requires state Medicaid programs to revalidate provider enrollments at intervals not to exceed every five years. The CMS revalidation requirement for durable medical equipment (DME) and home medical equipment (HME) providers, including pharmacy providers with DME or HME specialty enrollments, is more frequent, at intervals not to exceed every three years.

Indiana Health Coverage Programs (IHCP) providers will receive notification letters when it is time to revalidate their enrollments. Notification with instructions for revalidating are sent 90 and 60 days in advance of the revalidation deadline. Notices are mailed to the Service Location address indicated on the provider's service location profile. Providers with multiple service locations must revalidate the enrollment of each service location. Providers that fail to submit revalidation paperwork in a timely manner will be disenrolled from participation in the IHCP as of the revalidation due date indicated in the letter. After disenrollment, the provider will need to submit a new IHCP Provider Enrollment and Profile Maintenance Packet to re-enroll with the IHCP. Disenrollment with subsequent re-enrollment may result in a gap in the provider's eligibility. Providers should not attempt to revalidate until they receive their notification letter.

See Provider Enrollment Revalidation Due Dates Through June 2017 to view a list of providers with upcoming revalidation due dates.

Past-Due Revalidations and Provider Disenrollment

NOTE: Pursuant to federal regulations, all providers enrolled with the IHCP before January 1, 2012, must revalidate their enrollments by the deadline established by the CMS. The CMS has directed states to disenroll any provider that fails to revalidate. Affected providers that need to revalidate their enrollments should have received notification letters. Revalidation questions should be directed to Customer Assistance at 1-800-577-1278 (select the Provider Enrollment prompt).

How to Revalidate an Enrollment

To revalidate an enrollment, providers must complete the appropriate IHCP provider packet, the same as is required at initial enrollment. There is not a separate revalidation form.

  • To find the appropriate IHCP provider packet, go to Complete an IHCP Provider Packet on this site and select the link associated with your provider type.
  • Select the IHCP provider packet indicated for your provider classification and carefully review the instructions.
    • Indicate "Revalidate Enrollment" in field 1 on Schedule A, under Type of Request. Complete all other fields in the packet, attach the required documentation, and mail the packet to the address indicated.
    • Revalidation requires providers to complete all applicable information fields. It is not an update for which only additions, deletions, or changes are required.
    • Group providers do not need to submit new rendering provider packets during revalidation (disregard the IHCP Rendering Provider Enrollment and Profile Maintenance Packet at the end of the group provider packet). To revalidate the rendering providers linked to the group's service location at the time of revalidation, submit a list of those rendering providers, including the information outlined in the instructions, as an attachment to the group packet.
  • Providers are encouraged to review the IHCP Provider Enrollment Type and Specialty Matrix to determine supporting documentation requirements based on provider type.
  • Providers are encouraged to review the IHCP Provider Enrollment Risk Category and Application Fee Matrix to determine the screening criteria that apply to their provider specialty during revalidation and to determine whether an application fee is required. Providers subject to an application fee are required to pay the fee at the time of revalidation.

More Information

Revalidation requirements do not apply to practitioners enrolling only as ordering, prescribing, or referring (OPR) providers. See the Ordering, Prescribing or Referring Providers page on this site for more details about OPR providers.

Revalidation of enrollment is not the same as recertification of enrollment credentials. See Recertify Provider Enrollment Licenses and Other Certifications on this site for details about the recertification process.

For more information about provider enrollment revalidation, see the Provider Enrollment provider reference module.